Isotretinoin acne treatment

This study reports a new form of severe inflammatory exogenous acne due to the association of two factors facial friction with cosmetic agents. Females aged 15,17, and 19 years presented at the clinic with severe inflammatory acne. In all cases, the face has been strongly rubbed in a compulsory marmer in the previous weeks with cosmetic agents [14 ]. The disease has not responded to various conventional acne treatments and was well controlled by a combination of oral corticosteroids and low-dose isotretinoin (1ST). Because cosmetic face friction as a cosmetic care becomes more and more fashionable, dermatologists should be aware of this severe clinical condition, which can occur in patients without a personal history of acne. 

It is important to obtain details regarding isotretinoin (Accutane, Roacutane) treatment and history of keloid or hypertrophic scar formation. Isotretinoin use necessitates a delay period of 6-12 months (depending on the skin thickness and oiliness) until chemical peel is performed. Active acne is not a contraindication for chemical peel. In these cases the peel is combined with systemic antibiotics for 2-3 weeks. It is always advisable to consider isotretinoin treatment after the peel to avoid acne flare and scar reappearance. 

Systemic therapy for acne includes antibiotics, isotretinoin and hormones (Tables 11.8 and 11.9). Oral treatment is indicated in cases of 1) moderate and severe acne 2) acne with tendency to scars development and 3) psychological distress related to acne. 

Isotretinoin is effective in up to 80% of patients with severe nodulocystic acne who are unresponsive to other topical and oral treatment regimens.8,23,24 Isotretinoin works on the four... 

Oral isotretinoin is the treatment of choice in severe papulopustular acne and nodulocystic/conglobate acne. Hormonal therapy may be an effective alternative in female patients. 

Not infrequently, retinol is used for mild acne, and the more active retinoids such as retinoic acid, isotretinoin, and adapalene serve for the treatment of the more severe forms. Retinol incorporated into Compritol-based SLN has been released more rapidly and to a higher extent compared with conventional vehicles and with a ) 2005 by CRC Press LLC... 

In mild-to-moderate acne topical treatment such as benzoyl peroxide (Ponoxyl gel) is usually recommended, followed by clindamycin (Dalacin capsules). Rooccutone capsules, which contain isotretinoin, ore reserved for more severe cases of acne. 

Isotretinoin should be prescribed only by prescribers who have demonstrated special competence in the diagnosis and treatment of severe recalcitrant nodular acne, are experienced in the use of systemic retinoids, have read the SMART Guide to Best Practices, signed and returned the completed SMART letter of understanding, and obtained yellow self-adhesive Accutane qualification stickers. Do not prescribe or dispense Accutane without a yellow self-adhesive Accutane qualification sticker. 

Clinical improvement in nodular acne occurs in association with a reduction in sebum secretion. The decrease in sebum secretion is temporary, is related to the dose and duration of treatment with isotretinoin, and reflects a reduction in sebaceous gland size and an inhibition of sebaceous gland differentiation. Pharmacokinetics ... 

Minimal skeletal hyperostosis and calcification of ligaments and tendons has been observed by x-ray in prospective studies of nodular acne patients treated with a single course of therapy at recommended doses. The skeletal effects of multiple isotretinoin treatment courses for acne are unknown. 

Isotretinoin is most useful for the treatment of severe recalcitrant nodular acne vulgaris. It may also be... 

Pseudotumor cerebri is another potential complication of chronic use of these agents, particularly in individuals treated for severe cystic acne with simultaneous use of isotretinoin. This complication can be induced within several days of initiation of therapy and usually resolves with cessation of treatment. 

The past twenty years have witnessed considerable progress in the synthesis and use of other retinoid-like molecules related to vitamin A. The aromatic retinoid etretin (8.54) and its ester etretinate (8.55) had some effectiveness in the treatment of psoriasis, a disorder of skin. 13-cA-Retinoic acid (isotretinoin) produces sebaceous gland atrophy and could prove useful in the treatment of severe acne vulgaris. Although these compounds have toxic side effects and are not in regular use, they have opened up new therapeutic possibilities. Retinoic acid (tretinoin, 8.56) has been employed in the treatment of acne. 

Isotretinoin is a retinoid, recently approved for use in capsule form (10-20 mg). It decreases the amount of sebum that sebaceous glands produce. Isotretinoin exhibits antiproliferative and antiandrogenic effects on the sebaceous glands. It also interacts with the formation of androgens in sebaceous glands. It is indicated in the treatment of severe nodular acne, acne conglobata and recalcitrant acne. It is available in International market under the brand name ACCUTANE by Roche pharmaceuticals. 

Isotretinoin (Accutane) is a synthetic retinoid currently restricted to the oral treatment of severe cystic acne that is recalcitrant to standard therapies. The precise mechanism of action of isotretinoin in cystic acne is not known, although it appears to act by inhibiting sebaceous gland size and function. The drug is well absorbed, extensively bound to plasma albumin, and has an elimination half-life of 10-20 hours. 

Most patients with cystic acne respond to 1-2 mg/kg, given in two divided doses daily for 4-5 months. If severe cystic acne persists following this initial treatment, after a period of 2 months, a second course of therapy may be initiated. Common adverse effects resemble hypervitaminosis A and include dryness and itching of the skin and mucous membranes. Less common side effects are headache, corneal opacities, pseudotumor cerebri, inflammatory bowel disease, anorexia, alopecia, and muscle and joint pains. These effects are all reversible on discontinuance of therapy. Skeletal hyperostosis has been observed in patients receiving isotretinoin with premature closure of epiphyses noted in children... 

A change in dreaming pattern has been reported in two patients, occurring within 2-3 weeks after the start of treatment with isotretinoin 40 mg/day for cystic acne (684). One patient also reported increased irritability and bouts of depression. In both patients all the symptoms abated after 4-5 weeks without a change in isotretinoin dosage. 

Retinoids in Dermatology 13-Qs-retinoic acid (isotretinoin, Accutane ) is used orally, and all-trans-retinoic acid (Tretinoin ) topically, for treatment of severely disfiguring cystic acne. Etretinate (the trimethoxyphenyl analog of retinoic acid) and tazarotene (a receptor-specific retinoid) are used topically for the treatment of psoriasis. They are effective in cases in which other therapy has failed, and at lower levels than are required for the control of tumor development in experimental animals, although they have heen associated with hirth defects (Section 2.5.1.1 fohnson and Chandrarama, 1999). 

Isotretinoin, or 13-cw-retinoic acid, is widely used for the treatment of recalcitrant cystic acne. Although this drug more commonly affects the external tissues of the eye, causing ocular surface dryness, there is sufficient evidence to designate that this agent has a certain retinotoxic effect, causing nyctalopia. It also has a probably/likely designation for reversible decreases in color vision. 

Excessive use of vitamin A can result in ocular dryness, loss of lashes, night blindness, and even intracranial hypertension, the latter of which is similar to that occurring with the other forms of vitamin A such as isotretinoin, approved for the treatment of cystic acne. With large doses, increased intracranial pressure is considered certain. ... 

Goulden V, Layton AM, Cunliffe WJ. Long-term safety of isotretinoin as a treatment for acne vulgaris. Br J Dermatol 1994 131(3) 360-3. 

Hughes RA. Arthritis precipitated by isotretinoin treatment for acne vulgaris. J Rheumatol 1993 20(7) 1241-2. 

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